Emergency Response Code Emergency/Disaster Management CODE BLUE MEDICAL EMERGENCY/CARDIAC ARREST Code Blue Code Blue is a term used to alert the Code Team and hospital staff of the significant deterioration in a patient s status (e.g. unresponsiveness, absence of blood pressure, status epilepticus) indicating the immediate need for staff experienced in management emergent problems. Indications for Calling a Code Blue C CIRCULATION Absence of pulse A AIRWAY Occlusion of airway (immediate interventions are ineffective) B BREATHING Apnea (actual or impending) When a patient s circulation, airway and breathing are inadequate, the resident or attending physician should be contacted STAT and consulted prior to calling a Code Blue. Initiate CPR C A B Initiate Chest Compressions Open the Airway Deliver 2 Breaths If CPR is initiated, the Physician should be contacted STAT to advise that a Code Blue has been called. In addition to the Physician, the Emergency Medical Response Team shall be paged to assist with the resuscitation. 1
First Responders First Responder Assess the victim for unresponsiveness by painful stimuli and shouting Shout for help AND press the nearest Staff Call or Code Blue button and note time or press the emergency button on portable phone. Place the patient in supine position with the head of the bed flat Assess CAB (Circulation, Airway, Breathing) Obtain resuscitation trolley: Resuscitation trolley contains flowmeter, 0 2 tank& tubing, bagger, adult and pediatric oxygen masks, suction, defibrillator, medication, IV materials First Responder Remove ambu bag from the Resuscitation trolley Insert oral airway (if you have difficulty inserting the oral airway, proceed with bagging) Position bagger and start bagging If able, prior to positioning insert 0 2 flowmeter, attach 0 2 tubing, and set flowmeter at 15 L. Start CPR (Chest compressions, open the Airway, deliver 2 Breaths) Continue until otherwise directed by the nurse in charge or physician When help arrives, designate an individual to: Call Switchboard, 0 Bring the remainder of the emergency equipment If required, instruct to insert 0 2 flowmeter, attach 0 2 tubing, and set flowmeter at 15 L 2
Second Responder Ensure Switchboard is notified: Dial 0 State Code Blue State Unit Location and Room Number Wait for the Operator to repeat the above information. Take the following equipment to the victim s location: Stretcher IV pole backboard suction equipment Automated External Defibrillator (AED) / Monitor / Defibrillator Assist with CPR Inform patient s physician Call EMS team if they are available Ext. 333 Switchboard Response/in hours During switchboard hours: Activate paging system to alert Emergency and other unit teams to attend Code Blue Within one minute, announce over the public information system (3 times): Code Blue Location Room number 3
Switchboard Response/out of hours When switchboard is unavailable, the Emergency Department activates the Code Blue announcement. Activate paging system to alert other unit teams to attend Code Blue Within one minute, announce over the public information system (3 times): Code Blue Location Room number Post Resuscitation Immediately following stabilization of the patient, the Code Team Leader will decide whether critical care is required and will arrange for transport to the appropriate hospital using STARS or EMS for transportation The patient will be transferred to the Emergency department, trauma bed 2017/1 The attending physician is responsible for making the decision to transport the patient to a referral hospital and arranging for the transport via RAAPID 800.661.1700 The attending physician is responsible for informing the family about the code and the condition of the patient. The nurse in charge of the unit where the Code Blue occurred will inform the switchboard to announce Code Blue all clear. 4
Switchboard Response OR Call received from code blue OR Emergency Dept. Out of Hours Code button on central switch lights up Write location and room number down Repeat to caller: Code Blue Location and Room # Within 1 min. Announce over the public information system 3X Code Blue, location, Room # Code Blue, location, Room # Code Blue, location, Room # Call Dr. on call if you are sure there is no physician in the hospital Call 911 to dispatch Banff EMS to Hospital Wait to announce Code Blue all clear and repeat three times 5
Victim found Assess Unresponsiveness *Shout and Induce painful stimuli Responses appropriately? NO Shout for HELP and press Staff Call / Code Blue Button OR Pull call bell out of wall socket YES Note Time Place patient in supine position (flat on back) with head of bed flat C Circulation Absence of Pulse Initiate Chest Compressions Continue to assess need for further interventions and call emergency physician and/or admitting physician. Alert emergency nurses YES Assess Pulse no Pulse Start Chest Compressions Respirations and circulation adequate? A Airway Open the airway B Breathing Actual or Impending Give 2 breaths NO Get crash cart trolley Attach O2 flowmetre / tubing And set flow to 15 L/min. If O2 not readily available It can wait for second responder to attach Insert airway and begin bagging NO Start CPR Second responder arrives O2 attached and flowing? YES Second responder responsibilities Call Switchboard: Dial 0 State Code Blue Location and Room # Ask operator to repeat the info Assist with CPR: Insert backboard Attach monitor Assess CPR effectiveness Gather additional equipment Call EMS Team Inform patient s physician/ emergemcy physician 6